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Category: General

Published on Monday, 11 August 2008 14:19

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Activity scheduling, activity/rest cycling and goal setting
It is recognised (WHO²³) that occupation is a core human need that maintains health and well-being. Remaining active is an important ingredient for managing fibromyalgia. Over time, patients frequently report avoiding more and more activities that they associate with making their pain worse; or they may take this tack for a while, feel increasingly frustrated and when a "good day" comes along, they may play "catch-up" with all the activities they have put off. This way of trying to cope is understandable, common and has its own name, "activity cycling".²⁴

However, because fatigue and poor sleep are common adjuncts to fibromyalgia, it can be helpful to manage activity in a way that uses energy wisely. Prioritising, planning and pacing activity can make a significant impact on the amount people can do in the long term. Spreading activity out over the day or the week, rather than rushing to do everything at once, breaking tasks down into manageable "chunks" and using stretches and relaxation skills during activity can all help. Patients may also need to use problem solving skills to figure out new and creative ways of getting tasks done, within their own capabilities.

One of the barriers to continuing with activity can be the deconditioning that often occurs as muscles and joints fail to be used in the normal way because of pain. A graded exercise programme can help to gradually improve fitness, and encourage the use of the body through its full range of movements.

Although aids and equipment can appear tempting, it is helpful to stress the importance of patients being able to use their own body to manage daily activity. This will raise self-esteem and guard against the stress and frustration of not coping independently. A decision about whether or not to use aids and equipment should be carefully made, and not rushed into because of the ease of a short term solution.

If changes in activity management are to be made and sustained in the home, socially and at work, communication with family, friends and work colleagues will be important. Helping the patient to put their case for change, negotiate a way of balancing roles and responsibilities to maximise independence and working towards maximising the fun and social contact they have requires assertive communication. This is sometimes lost when pain and fatigue impact on self-confidence, but with practice can be regained and make a significant difference to enjoyment in life.

Patients sometimes find it difficult to make changes in established habits of "doing". Engaging them in a process of trying new things, and then reporting back the benefits or costs will be part of helping them to decide on the strategies they feel able to make a part of their life. It will need to be stressed that any benefit in increased activity may be slow to happen, but that pacing has been shown to have positive effects.

However, these strategies are about helping each individual to get in touch with the core values in their lives, to set goals that will move them towards their core values, and to manage each day in a way that is meaningful and productive to them.²⁵ It will not necessarily reduce pain.

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